Statement of Research Interests

In Asia, there is an imperative need to implement the practice of evidence-based public health policy, planning, and spending. My earlier and ongoing research provides the appropriate evidence, which can guide the formulation of policy to bring in positive change that we can see in our lifetime. I am focused shaping my career towards independence and in building a long-term career in academic public health. Therefore, my future research plan is dedicated to exploring the impact of tackling determinants in the maternal and psychosocial environment and thereby promote positive health in populations through appropriate interventions.

The focus of my research is through the realization of the following objectives.

Objectives (a) and (b) help in identification and prioritization of maternal determinants of childhood obesity (and subsequent risk of diabetes and hypertension) in Asia. The evidence available in the next three years will aid in the generation of rigorous, feasible and contextually specific population-based pilot interventions. The objective (c) will be achieved through the implementation of pilot interventions based on objectives (a) & (b). The three objectives together will contribute to logical and empirically grounded choices of public health interventions.

In the next few years, I want to pilot the interventions based on the results of the research on the role of the maternal and psychosocial environment of NCDs in different populations. The overall results from testing the interventions will result in the implementation of evidence-based public health. In the next 5 years, I wish to inculcate the evidence into policy formulations at the national and international level to influence policymakers to bring positive changes with respect to NCD prevention and control. Due to demographic transition and lifestyle changes, the aging Asian populations continually are affected by NCDs. My engagement of research and advocacy in NCDs will aid in improving the health of an aging population and improve productivity. I am uniquely positioned to study the effects from an intergenerational perspective and earnestly believe that the positive changes will see the transformation of societies in the next two decades. Therefore, my long-term goal is to ensure healthy populations are sustained through integrated technical and advocacy efforts. My track record of working in public health over 17 years has provided a clear resolve for the achieving the objectives listed above.

Ongoing Research Projects .

Maternal Antecedents of Adiposity and Studying the Transgenerational role of Hyperglycemia and Insulin (MAASTHI): a prospective cohort study.Funded by Wellcome Trust DBT India Alliance: Link1Link2 Link3

Full meal supplementation: Evaluation of Effect in Pregnant and Lactating women (FEEL): Funded by Department of Women and Child, Government of Karnataka

Ambient and Indoor Air Pollution in Pregnancy on the risk of Low birth weight and Ensuing Effects in Infants (APPLE); A cohort study in South India. Funded by Department of Science & Technology, Government of India

Details of the Ongoing Research Projects

Maternal Antecedents of Adiposity and Studying the Transgenerational role of Hyperglycemia and Insulin (MAASTHI): a prospective cohort study. Funded by Wellcome Trust DBT India Alliance:Link1Link2 Link3

India is experiencing an epidemic of obesity-hyperglycaemia, which can be sustained and augmented through transgenerational transmission of adiposity and glucose intolerance in women. This presents an opportunity for exploring a clear strategy for the control of this epidemic in India. We conducted a study between November 2013 and May 2015 to inform the design of a large pregnancy cohort study. Based on the findings of this pilot, Currently, we are recruiting women in a birth cohort since April 2016. The protocol of the study documents the processes which aim at advancing the available knowledge, linking several steps in the evolution of obesity led hyperglycemia.

Maternal Antecedents of Adiposity and Studying the Transgenerational role of Hyperglycemia and Insulin (MAASTHI) is a cohort study in the public health facilities in Bangalore, India. The objective of MAASTHI is to prospectively assess the effects of glucose levels in pregnancy on the risk of adverse infant outcomes, especially in predicting the possible risk markers of later chronic diseases. The primary objective of the proposed study is to investigate the effect of glucose levels in pregnancy on skinfold thickness (adiposity) in infancy as a marker of future obesity and diabetes in offspring. The secondary objective is to assess the association between the psychosocial environment of mothers and adverse neonatal outcomes including adiposity. The study aims to recruit 5000 pregnant women and follow them and their offspring for a period of 4 years.

The carbohydrate ‘fuel’ metabolism in a pregnant woman may have a long-term impact on the development of her offspring (‘fuel-mediated teratogenesis’ hypothesis) including in utero exposure to maternal hyperglycemia leading to fetal hyperinsulinemia, and the consequent increase in fetal fat cells. Therefore, a feed-forward loop can exist of rising adiposity and hyperinsulinemia throughout childhood, perhaps leading to obesity and diabetes in later life. There is a need for prospective examination of body fat distribution in children born to mothers with different glycemic levels to understand the plausible association between glucose metabolism and future risk of diabetes in offspring.

We published detailed protocols of the study and pilot in open access peer-reviewed journals. (BMC, BMJOpen) In order to extend the recruitment, complete the follow-up and create a bio-repository, I have been awarded intermediate fellowship from Wellcome trust-DBT India alliance. With the funding support of WT-DBT India alliance, I am currently expanding the cohort study to aim to recruit more than 3000 pregnant women. Extending the study to multiple centers will provide the robust data for valid inferences.

Accomplishments

The knowledge from this study may be extremely important for developing an effective strategy for the control of the obesity-hyperglycaemia epidemic in low-income and middle-income countries. The results from our study can provide insights into the relation of adiposity during infancy and childhood into adult adiposity and Type 2 Diabetes Mellitus (T2DM).

We have been able to recruit more than 700 pregnant women. All women have undergone Hb and OGTT (Fasting and 2 Hr PPBS with 75g glucose).

Additional funding requests are underway for expansion of the birth cohort and for testing the additional hypotheses.

Publications from this project are as follows:- (also visit, publications)

“Association of Obesity with hypertension and Type-2 Diabetes Mellitus in India A meta-analysis of observational studies” (In Peer review)

Two more papers in review

2. Full meal supplementation: Evaluation of Effect in Pregnant and Lactating women (FEEL): Funded by Department of Women and Child, Government of Karnataka

*Under Development*

3. Ambient and Indoor Air Pollution in Pregnancy on the risk of Low birth weight and Ensuing Effects in Infants (APPLE); A cohort study in South India. Funded by Department of Science & Technology, Government of India

*Under Development*

Details of Earlier Research

[2009-2012, University of California Los Angeles]

Summary: Hypertension is a major contributor to the worldwide epidemic of cardiovascular disease (CVD).[1,2] It is estimated that hypertension causes 7.5 million deaths worldwide amounting to 12.8% of the total of all annual deaths.[3] Many risk factors leading to hypertension are modifiable and therefore provide an opportunity for preventive efforts.[4] There is an imperative need for population-based research to understand the modifiable factors such as job stress in leading to Hypertension.[4] I chose workplace settings for the research as they provide opportunities to explore determinants of these negative behaviors and are amenable to interventions.[1]

I led a moderately large study (N = 1071) in the software professionals in Bangalore, India employed at 27 different IT companies. The focus of our study was to study the association of Job stress and Hypertension as well as understanding the on the age gradient of hypertension prevalence. The research established higher prevalence of hypertension in the younger age cohort, affecting 31% professionals with 5% having malignant levels of hypertension. It was known earlier that south Asians are predisposed to be hypertensive a decade earlier compared the developed countries.[6] Our research suggested that hypertension in IT/ITES professionals occurs a decade earlier compared to the rest of India and two decades earlier compared to developed countries.[7] This suggests that if untreated, these professionals would go on to develop cardiovascular diseases (CVD) at an early age. The results also indicated that 46% of professionals were in pre-hypertension. In addition, I found that the dimensions of workplace autonomy and workplace environment are associated with hypertension.

Accomplishments

The earlier understanding was that the association between job strain and coronary heart disease (CHD) is weak, with job strain slightly increasing the risk of coronary diseases by 3.4% in the general population.[9] Our meta-analysis showed statistically significant associations with 30% higher risk of hypertension for those with job strain. This proves that job strain might be affecting the CHDs through hypertension. The paper on the meta-analysis of job stress and hypertension, therefore, is a significant contribution to the body of literature and would influence future research delineating the effects of stress on CHDs. As a testimony to the impact of the paper, the original paper by us was republished by the BMJ group in their postgraduate medical journal.

It is important that individuals with higher stress have to change their lifestyle to prevent a progressive rise in BP using the recommended lifestyle modifications. [8] As a result of the findings from the study, the software companies have approached us and have requested to engage with them for improving health outcomes. I am in discussion with a major IT company to finalize the details of engagement towards improving the health of the employees.

I have published extensively on this work. The Publications from this project are as follows.

Subsequent to the study in software professionals, we have now conducted the study in schoolteachers and employees of the health department. These studies are helping us to collate evidence on the worksite-based burden of NCDs and are helpful in designing the appropriate interventions. A series of papers are pending for publications on the burden of the diseases in different workgroups.

Parimala, Giridhara R Babu, The Burden of Diabetes And Hypertension in the staff working in Directorate Of Health And Family Welfare Services, Bengaluru, Karnataka. [In press]